|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$356.16
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: Aetna Medicare |
$92.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.30
|
| Rate for Payer: BCBS Complete |
$65.93
|
| Rate for Payer: BCBS MAPPO |
$89.04
|
| Rate for Payer: BCBS Trust/PPO |
$292.80
|
| Rate for Payer: BCN Commercial |
$292.80
|
| Rate for Payer: BCN Medicare Advantage |
$89.04
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.04
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Mclaren Medicaid |
$62.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.49
|
| Rate for Payer: Meridian Medicaid |
$65.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.74
|
| Rate for Payer: Nomi Health Commercial |
$292.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.12
|
| Rate for Payer: PACE Senior Care Partners |
$84.59
|
| Rate for Payer: PACE SWMI |
$89.04
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: PHP Medicare Advantage |
$89.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$309.86
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.89
|
| Rate for Payer: Railroad Medicare Medicare |
$89.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.42
|
| Rate for Payer: UHC Core |
$297.39
|
| Rate for Payer: UHC Exchange |
$89.04
|
| Rate for Payer: UHC Medicaid |
$62.79
|
| Rate for Payer: UHC Medicare Advantage |
$89.04
|
| Rate for Payer: UHCCP Medicaid |
$62.79
|
| Rate for Payer: VA VA |
$89.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 60687041511
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.95
|
| Rate for Payer: BCN Commercial |
$2.95
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.68
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 60687041511
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.68
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicaid |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: UHCCP Medicaid |
$0.63
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
OP
|
$751.10
|
|
|
Service Code
|
NDC 00378086001
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.42 |
| Max. Negotiated Rate |
$675.99 |
| Rate for Payer: Aetna Commercial |
$638.43
|
| Rate for Payer: Aetna Medicare |
$195.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.72
|
| Rate for Payer: BCBS Complete |
$139.03
|
| Rate for Payer: BCBS MAPPO |
$187.78
|
| Rate for Payer: BCBS Trust/PPO |
$617.48
|
| Rate for Payer: BCN Commercial |
$617.48
|
| Rate for Payer: BCN Medicare Advantage |
$187.78
|
| Rate for Payer: Cash Price |
$600.88
|
| Rate for Payer: Cofinity Commercial |
$645.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.78
|
| Rate for Payer: Healthscope Commercial |
$675.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.33
|
| Rate for Payer: Mclaren Medicaid |
$132.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.16
|
| Rate for Payer: Meridian Medicaid |
$139.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.43
|
| Rate for Payer: Nomi Health Commercial |
$615.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.33
|
| Rate for Payer: PACE Senior Care Partners |
$178.39
|
| Rate for Payer: PACE SWMI |
$187.78
|
| Rate for Payer: PHP Commercial |
$638.43
|
| Rate for Payer: PHP Medicare Advantage |
$187.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$653.46
|
| Rate for Payer: Priority Health Medicare |
$189.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$522.77
|
| Rate for Payer: Railroad Medicare Medicare |
$187.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.97
|
| Rate for Payer: UHC Core |
$627.17
|
| Rate for Payer: UHC Exchange |
$187.78
|
| Rate for Payer: UHC Medicaid |
$132.42
|
| Rate for Payer: UHC Medicare Advantage |
$187.78
|
| Rate for Payer: UHCCP Medicaid |
$132.42
|
| Rate for Payer: VA VA |
$187.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.33
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$356.16
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.89 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: BCBS Trust/PPO |
$294.15
|
| Rate for Payer: BCN Commercial |
$294.15
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.74
|
| Rate for Payer: Nomi Health Commercial |
$292.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.12
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$309.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.42
|
| Rate for Payer: UHC Core |
$297.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
CLOZAPINE 100 MG TABLET
|
Facility
|
IP
|
$751.10
|
|
|
Service Code
|
NDC 00378086001
|
| Hospital Charge Code |
9647
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$522.77 |
| Max. Negotiated Rate |
$675.99 |
| Rate for Payer: Aetna Commercial |
$638.43
|
| Rate for Payer: BCBS Trust/PPO |
$620.33
|
| Rate for Payer: BCN Commercial |
$620.33
|
| Rate for Payer: Cash Price |
$600.88
|
| Rate for Payer: Cofinity Commercial |
$645.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.88
|
| Rate for Payer: Healthscope Commercial |
$675.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$638.43
|
| Rate for Payer: Nomi Health Commercial |
$615.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.33
|
| Rate for Payer: PHP Commercial |
$638.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$653.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$522.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.97
|
| Rate for Payer: UHC Core |
$627.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.33
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$285.95
|
|
|
Service Code
|
NDC 60687040401
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.02 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: BCBS Trust/PPO |
$236.17
|
| Rate for Payer: BCN Commercial |
$236.17
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.46
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$285.95
|
|
|
Service Code
|
NDC 60687040401
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$257.36 |
| Rate for Payer: Aetna Commercial |
$243.06
|
| Rate for Payer: Aetna Medicare |
$74.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.36
|
| Rate for Payer: BCBS Complete |
$52.93
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$235.08
|
| Rate for Payer: BCN Medicare Advantage |
$71.49
|
| Rate for Payer: Cash Price |
$228.76
|
| Rate for Payer: Cofinity Commercial |
$245.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.49
|
| Rate for Payer: Healthscope Commercial |
$257.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.46
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: Meridian Medicaid |
$52.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.06
|
| Rate for Payer: Nomi Health Commercial |
$234.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.46
|
| Rate for Payer: PACE Senior Care Partners |
$67.91
|
| Rate for Payer: PACE SWMI |
$71.49
|
| Rate for Payer: PHP Commercial |
$243.06
|
| Rate for Payer: PHP Medicare Advantage |
$71.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.78
|
| Rate for Payer: Priority Health Medicare |
$72.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.02
|
| Rate for Payer: Railroad Medicare Medicare |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$238.77
|
| Rate for Payer: UHC Exchange |
$71.49
|
| Rate for Payer: UHC Medicaid |
$50.41
|
| Rate for Payer: UHC Medicare Advantage |
$71.49
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$71.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.46
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 60687040411
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$0.53
|
| Rate for Payer: BCBS MAPPO |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: BCN Medicare Advantage |
$0.72
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.72
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.72
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.49
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: Railroad Medicare Medicare |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHC Medicaid |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: UHCCP Medicaid |
$0.50
|
| Rate for Payer: VA VA |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
CLOZAPINE 25 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 60687040411
|
| Hospital Charge Code |
9648
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$6,766.51
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$6,444.29 |
| Max. Negotiated Rate |
$6,766.51 |
| Rate for Payer: BCBS Complete |
$6,766.51
|
| Rate for Payer: Mclaren Medicaid |
$6,444.29
|
| Rate for Payer: Meridian Medicaid |
$6,766.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,444.29
|
| Rate for Payer: UHC Medicaid |
$6,444.29
|
| Rate for Payer: UHCCP Medicaid |
$6,444.29
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$14,857.08
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$14,149.60 |
| Max. Negotiated Rate |
$14,857.08 |
| Rate for Payer: BCBS Complete |
$14,857.08
|
| Rate for Payer: Mclaren Medicaid |
$14,149.60
|
| Rate for Payer: Meridian Medicaid |
$14,857.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,149.60
|
| Rate for Payer: UHC Medicaid |
$14,149.60
|
| Rate for Payer: UHCCP Medicaid |
$14,149.60
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$4,068.42
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$3,874.69 |
| Max. Negotiated Rate |
$4,068.42 |
| Rate for Payer: BCBS Complete |
$4,068.42
|
| Rate for Payer: Mclaren Medicaid |
$3,874.69
|
| Rate for Payer: Meridian Medicaid |
$4,068.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,874.69
|
| Rate for Payer: UHC Medicaid |
$3,874.69
|
| Rate for Payer: UHCCP Medicaid |
$3,874.69
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$24,318.52
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$23,160.50 |
| Max. Negotiated Rate |
$24,318.52 |
| Rate for Payer: BCBS Complete |
$24,318.52
|
| Rate for Payer: Mclaren Medicaid |
$23,160.50
|
| Rate for Payer: Meridian Medicaid |
$24,318.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,160.50
|
| Rate for Payer: UHC Medicaid |
$23,160.50
|
| Rate for Payer: UHCCP Medicaid |
$23,160.50
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$11,248.24
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$10,712.61 |
| Max. Negotiated Rate |
$11,248.24 |
| Rate for Payer: BCBS Complete |
$11,248.24
|
| Rate for Payer: Mclaren Medicaid |
$10,712.61
|
| Rate for Payer: Meridian Medicaid |
$11,248.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,712.61
|
| Rate for Payer: UHC Medicaid |
$10,712.61
|
| Rate for Payer: UHCCP Medicaid |
$10,712.61
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$2,716.49
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$2,587.13 |
| Max. Negotiated Rate |
$2,716.49 |
| Rate for Payer: BCBS Complete |
$2,716.49
|
| Rate for Payer: Mclaren Medicaid |
$2,587.13
|
| Rate for Payer: Meridian Medicaid |
$2,716.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,587.13
|
| Rate for Payer: UHC Medicaid |
$2,587.13
|
| Rate for Payer: UHCCP Medicaid |
$2,587.13
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,451.09
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$3,286.75 |
| Max. Negotiated Rate |
$3,451.09 |
| Rate for Payer: BCBS Complete |
$3,451.09
|
| Rate for Payer: Mclaren Medicaid |
$3,286.75
|
| Rate for Payer: Meridian Medicaid |
$3,451.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,286.75
|
| Rate for Payer: UHC Medicaid |
$3,286.75
|
| Rate for Payer: UHCCP Medicaid |
$3,286.75
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,529.59
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$4,313.89 |
| Max. Negotiated Rate |
$4,529.59 |
| Rate for Payer: BCBS Complete |
$4,529.59
|
| Rate for Payer: Mclaren Medicaid |
$4,313.89
|
| Rate for Payer: Meridian Medicaid |
$4,529.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,313.89
|
| Rate for Payer: UHC Medicaid |
$4,313.89
|
| Rate for Payer: UHCCP Medicaid |
$4,313.89
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$742.26
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.61 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: BCBS Trust/PPO |
$613.03
|
| Rate for Payer: BCN Commercial |
$613.03
|
| Rate for Payer: Cash Price |
$593.81
|
| Rate for Payer: Cofinity Commercial |
$638.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$593.81
|
| Rate for Payer: Healthscope Commercial |
$668.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.92
|
| Rate for Payer: Nomi Health Commercial |
$608.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$556.70
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$645.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.19
|
| Rate for Payer: UHC Core |
$619.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$372.41
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna Medicare |
$96.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.38
|
| Rate for Payer: BCBS Complete |
$68.93
|
| Rate for Payer: BCBS MAPPO |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$306.16
|
| Rate for Payer: BCN Commercial |
$306.16
|
| Rate for Payer: BCN Medicare Advantage |
$93.10
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.31
|
| Rate for Payer: Mclaren Medicaid |
$65.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.76
|
| Rate for Payer: Meridian Medicaid |
$68.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.55
|
| Rate for Payer: Nomi Health Commercial |
$305.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PACE Senior Care Partners |
$88.45
|
| Rate for Payer: PACE SWMI |
$93.10
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: PHP Medicare Advantage |
$93.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.00
|
| Rate for Payer: Priority Health Medicare |
$94.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.20
|
| Rate for Payer: Railroad Medicare Medicare |
$93.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.72
|
| Rate for Payer: UHC Core |
$310.96
|
| Rate for Payer: UHC Exchange |
$93.10
|
| Rate for Payer: UHC Medicaid |
$65.66
|
| Rate for Payer: UHC Medicare Advantage |
$93.10
|
| Rate for Payer: UHCCP Medicaid |
$65.66
|
| Rate for Payer: VA VA |
$93.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.31
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$122.69
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$110.42 |
| Rate for Payer: Aetna Commercial |
$104.29
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.34
|
| Rate for Payer: BCBS Complete |
$22.71
|
| Rate for Payer: BCBS MAPPO |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$100.86
|
| Rate for Payer: BCN Commercial |
$100.86
|
| Rate for Payer: BCN Medicare Advantage |
$30.67
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cofinity Commercial |
$105.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.67
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.02
|
| Rate for Payer: Mclaren Medicaid |
$21.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.21
|
| Rate for Payer: Meridian Medicaid |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.29
|
| Rate for Payer: Nomi Health Commercial |
$100.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.02
|
| Rate for Payer: PACE Senior Care Partners |
$29.14
|
| Rate for Payer: PACE SWMI |
$30.67
|
| Rate for Payer: PHP Commercial |
$104.29
|
| Rate for Payer: PHP Medicare Advantage |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.74
|
| Rate for Payer: Priority Health Medicare |
$30.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.39
|
| Rate for Payer: Railroad Medicare Medicare |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.97
|
| Rate for Payer: UHC Core |
$102.45
|
| Rate for Payer: UHC Exchange |
$30.67
|
| Rate for Payer: UHC Medicaid |
$21.63
|
| Rate for Payer: UHC Medicare Advantage |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$21.63
|
| Rate for Payer: VA VA |
$30.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.02
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
OP
|
$742.26
|
|
|
Service Code
|
NDC 64764011907
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.86 |
| Max. Negotiated Rate |
$668.03 |
| Rate for Payer: Aetna Commercial |
$630.92
|
| Rate for Payer: Aetna Medicare |
$192.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.96
|
| Rate for Payer: BCBS Complete |
$137.39
|
| Rate for Payer: BCBS MAPPO |
$185.56
|
| Rate for Payer: BCBS Trust/PPO |
$610.21
|
| Rate for Payer: BCN Commercial |
$610.21
|
| Rate for Payer: BCN Medicare Advantage |
$185.56
|
| Rate for Payer: Cash Price |
$593.81
|
| Rate for Payer: Cofinity Commercial |
$638.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$593.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.56
|
| Rate for Payer: Healthscope Commercial |
$668.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.70
|
| Rate for Payer: Mclaren Medicaid |
$130.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.84
|
| Rate for Payer: Meridian Medicaid |
$137.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$204.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.92
|
| Rate for Payer: Nomi Health Commercial |
$608.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$556.70
|
| Rate for Payer: PACE Senior Care Partners |
$176.29
|
| Rate for Payer: PACE SWMI |
$185.56
|
| Rate for Payer: PHP Commercial |
$630.92
|
| Rate for Payer: PHP Medicare Advantage |
$185.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$645.77
|
| Rate for Payer: Priority Health Medicare |
$187.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.61
|
| Rate for Payer: Railroad Medicare Medicare |
$185.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.19
|
| Rate for Payer: UHC Core |
$619.79
|
| Rate for Payer: UHC Exchange |
$185.56
|
| Rate for Payer: UHC Medicaid |
$130.86
|
| Rate for Payer: UHC Medicare Advantage |
$185.56
|
| Rate for Payer: UHCCP Medicaid |
$130.86
|
| Rate for Payer: VA VA |
$185.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.70
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$122.69
|
|
|
Service Code
|
NDC 70710135103
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.39 |
| Max. Negotiated Rate |
$110.42 |
| Rate for Payer: Aetna Commercial |
$104.29
|
| Rate for Payer: BCBS Trust/PPO |
$101.33
|
| Rate for Payer: BCN Commercial |
$101.33
|
| Rate for Payer: Cash Price |
$98.15
|
| Rate for Payer: Cofinity Commercial |
$105.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.15
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.29
|
| Rate for Payer: Nomi Health Commercial |
$100.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.02
|
| Rate for Payer: PHP Commercial |
$104.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.97
|
| Rate for Payer: UHC Core |
$102.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.02
|
|
|
COLCHICINE 0.6 MG TABLET
|
Facility
|
IP
|
$372.41
|
|
|
Service Code
|
NDC 00904712004
|
| Hospital Charge Code |
1821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: BCBS Trust/PPO |
$307.57
|
| Rate for Payer: BCN Commercial |
$307.57
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.55
|
| Rate for Payer: Nomi Health Commercial |
$305.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.31
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.72
|
| Rate for Payer: UHC Core |
$310.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.31
|
|
|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
OP
|
$563.91
|
|
|
Service Code
|
NDC 59762045001
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$507.52 |
| Rate for Payer: Aetna Commercial |
$479.32
|
| Rate for Payer: Aetna Medicare |
$146.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.22
|
| Rate for Payer: BCBS Complete |
$104.38
|
| Rate for Payer: BCBS MAPPO |
$140.98
|
| Rate for Payer: BCBS Trust/PPO |
$463.59
|
| Rate for Payer: BCN Commercial |
$463.59
|
| Rate for Payer: BCN Medicare Advantage |
$140.98
|
| Rate for Payer: Cash Price |
$451.13
|
| Rate for Payer: Cofinity Commercial |
$484.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.98
|
| Rate for Payer: Healthscope Commercial |
$507.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$422.93
|
| Rate for Payer: Mclaren Medicaid |
$99.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.03
|
| Rate for Payer: Meridian Medicaid |
$104.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.32
|
| Rate for Payer: Nomi Health Commercial |
$462.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.93
|
| Rate for Payer: PACE Senior Care Partners |
$133.93
|
| Rate for Payer: PACE SWMI |
$140.98
|
| Rate for Payer: PHP Commercial |
$479.32
|
| Rate for Payer: PHP Medicare Advantage |
$140.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$490.60
|
| Rate for Payer: Priority Health Medicare |
$142.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.48
|
| Rate for Payer: Railroad Medicare Medicare |
$140.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.24
|
| Rate for Payer: UHC Core |
$470.86
|
| Rate for Payer: UHC Exchange |
$140.98
|
| Rate for Payer: UHC Medicaid |
$99.42
|
| Rate for Payer: UHC Medicare Advantage |
$140.98
|
| Rate for Payer: UHCCP Medicaid |
$99.42
|
| Rate for Payer: VA VA |
$140.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$422.93
|
|
